Provider Demographics
NPI:1770762734
Name:SCHMIDT, HILARY ROSE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HILARY
Middle Name:ROSE
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:HILARY
Other - Middle Name:ROSE
Other - Last Name:CAMMACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5510 ALMA LANE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SPRINFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151
Mailing Address - Country:US
Mailing Address - Phone:703-642-5990
Mailing Address - Fax:703-642-5991
Practice Address - Street 1:5510 ALMA LANE
Practice Address - Street 2:SUITE 400
Practice Address - City:SPRINFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151
Practice Address - Country:US
Practice Address - Phone:703-642-5990
Practice Address - Fax:703-642-5991
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001001097363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
2759162Medicare PIN